While still in residency, I met a patient in her early 90s with a history of colon cancer. Whenever I recommended surveillance tests, she told me to save Medicare dollars for younger people. She always expressed her appreciation for our team’s care, but she was matter of fact about how she had outlived her peers and did not want money or time spent on “frivolous tests.” When we noticed that her blood pressure was persistently high, despite her antihypertensive medication prescriptions, she accepted our offer to help manage daily medications. She started bringing a crumpled paper bag of medications to her visits. It was the same bag each time but with a different combination of pill bottles; many were outdated or had been discontinued. We were afraid that she was missing doses, but we also worried about the dangers of her taking extra pills or a lethal combination of medications. She came for monthly visits where we helped her fill pill containers for each day of the month. We also convinced her to discard expired and discontinued medications. I was still perplexed by the odd combination of bottles that kept appearing at these visits, so I arranged to visit her at home.
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DeVoe JE. The Incompatibility of Patient-Centered Care With Fee-for-Service Payment. JAMA Intern Med. 2020;180(12):1572–1573. doi:10.1001/jamainternmed.2020.4341
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